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Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of imaging in the management of progressive glioblastoma in adults

Abstract

Target population

These recommendations apply to adults with glioblastoma who have been previously treated with first-line radiation or chemoradiotherapy and who are suspected of experiencing tumor progression.

Question: In patients with previously treated glioblastoma, is standard contrast-enhanced magnetic resonance imaging including diffusion weighted imaging useful for diagnosing tumor progression and differentiating progression from treatment-related changes?

Level II: Magnetic resonance imaging with and without gadolinium enhancement including diffusion weighted imaging is recommended as the imaging surveillance method to detect the progression of previously diagnosed glioblastoma.

Question: In patients with previously treated glioblastoma, does magnetic resonance spectroscopy add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement?

Level II: Magnetic resonance spectroscopy is recommended as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma.

Question: In patients with previously treated glioblastoma, does magnetic resonance perfusion add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement?

Level III: Magnetic resonance perfusion is suggested as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma.

Question: In patients with previously treated glioblastoma, does the addition of single-photon emission computed tomography (SPECT) provide additional useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement?

Level III: Single-photon emission computed tomography imaging is suggested as a diagnostic method to differentiate true tumor progression from treatment-related imaging changes or pseudo-progression in patients with suspected progressive glioblastoma.

Question: In patients with previously treated glioblastoma, does 18F-fluorodeoxyglucose positron emission tomography add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement?

Level III: The routine use of 18F-fluorodeoxyglucose positron emission tomography to identify progression of glioblastoma is not recommended.

Question: In patients with previously treated glioblastoma, does positron emission tomography with amino acid agents add useful information for diagnosing tumor progression and differentiating progression from treatment-related changes beyond that derived from standard magnetic resonance imaging with and without gadolinium enhancement?

Level III: It is suggested that amino acid positron emission tomography be considered to assist in the differentiation of progressive glioblastoma from treatment related changes.

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Fig. 1

Data availability

The data generated during and/or analyzed during the current study are available via www.cns.org/guidelines.

Abbreviations

AA:

Amino acid

AANS:

American Association of Neurological Surgeons

AMT:

α-[11C]-methyl-l-tryptophan

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

ceMR:

Contrast-enhanced magnetic resonance imaging

CBV:

Cerebral blood volume

CI:

Confidence interval

CNS:

Congress of neurological surgeons

DCE:

Dynamic contrast enhanced

DSC:

Dynamic susceptibility contrast

DWI:

Diffusion weighted imaging

FDOPA:

3,4-Dihydroxy-6-[18F]-fluoro-l-phenylalanine

FET:

O-(2-[18F]-fluoroethyl)- l -tyrosine

FLT:

18F-fluorothymidine

FDG:

18F-fluorodeoxyglucose

HGG:

High-grade glioma

IDH:

Isocitrate dehydrogenase

MET:

11C-methyl-methionine

MR:

Magnetic resonance

MRS:

Magnetic resonance spectroscopy

NAA:

N-acetylaspartate

OS:

Overall survival

PET:

Positron emission tomography

PFS:

Progression free survival

RANO:

Response assessment in neuro-oncology

rCBV:

Relative cerebral blood volume

SPECT:

Single photon emission computed tomography

VEGF:

Vascular endothelial growth factor

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Acknowledgements

The guidelines task force would like to acknowledge the Congress of Neurological Surgeons Guidelines Committee for their contributions throughout the development of the guideline, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee for their review, comments, and suggestions throughout peer review, as well as the contributions of Trish Rehring, MPH, CHES, Senior Manager of Clinical Practice Guidelines for the CNS, and Mary Bodach, MLIS, from the Congress of Neurological Surgeons Guidelines Office for organizational assistance and reference librarian services, respectively as well as Jeremy Kupsco, PhD, Informationist, Emory University, for their valuable input as Medical Research Librarians. Throughout the review process, the reviewers and authors were blinded from one another. At this time the guidelines task force would like to acknowledge the following individual peer reviewers for their contributions: John O’Toole, MD, Brian Howard, MD, Jamie Van Gompel, MD, Howard Silberstein, MD, Navid Redjal, MD and Shawn Hervey-Jumper, MD.

Funding

These guidelines were funded exclusively by the Congress of Neurological Surgery and the Joint Section on Tumors of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, which received no funding from any outside commercial sources to support the development of this document.

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Correspondence to Derek Richard Johnson.

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All Guideline Task Force members were required to disclose all potential COIs prior to beginning work on the guideline, using the COI disclosure form of the AANS/CNS Joint Guidelines Review Committee. The CNS Guidelines Committee and Guideline Task Force Chair reviewed the disclosures and either approved or disapproved the nomination and participation on the task force. The CNS Guidelines Committee and Guideline Task Force Chair may approve nominations of task force members with possible conflicts and restrict the writing, reviewing, and/or voting privileges of that person to topics that are unrelated to the possible COIs. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this series of articles.

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Johnson, D.R., Glenn, C.A., Javan, R. et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of imaging in the management of progressive glioblastoma in adults. J Neurooncol 158, 139–165 (2022). https://doi.org/10.1007/s11060-021-03853-0

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Keywords

  • Diffusion
  • Glioblastoma
  • Imaging
  • MRI
  • Perfusion
  • PET
  • Spectroscopy